[STUDY GUIDE] • HIGH-YIELD PRACTICE & REVIEW EDITION
AHIP Final Exam 2026/2027 Verified
Exam Questions with Solutions and
Correct Answer Keys
Comprehensive Examination Question Bank • Concept Mapping
TOTAL QUESTIONS EXAM TOPICS ANSWERS
57 Questions 12 Modules 100% Verified
DOCUMENT OVERVIEW
This document contains 57 verified questions with correct answers and detailed rationales focused on
Medicare Advantage and related policies. It provides essential insights into the operational and regulatory
aspects of Medicare programs, making it suitable for study, review, and certification preparation in health
insurance and Medicare policy.
EXAM BLUEPRINT & TOPIC DISTRIBUTION
Systematic breakdown of subject domains and exam coverage.
Topic Module Scope & Core Focus Questions Share (%)
This topic covers the enrollment processes and eligibility
Medicare Advantage Enrollment criteria for Medicare Advantage plans. 5 Qs 8.8%
This topic examines the rules and provisions regarding
Supplemental Benefits supplemental benefits offered in Medicare Advantage plans. 5 Qs 8.8%
This topic focuses on the metrics and implications of quality
Quality Bonus Payments bonus payments for Medicare Advantage plans. 5 Qs 8.8%
This topic addresses various cost-sharing mechanisms and
Cost Sharing and Payments payment structures within Medicare Advantage. 5 Qs 8.8%
This topic explores telehealth provisions and their integration
Telehealth Services into Medicare Advantage plans. 5 Qs 8.8%
This topic investigates the role of provider networks and their
Provider Networks impact on beneficiary choices in Medicare Advantage. 5 Qs 8.8%
Confidential • Student Study Edition • Practice & Review Guide Page 1 of 30
,STUDENT STUDY & MASTERY EDITION PRACTICE & REVIEW GUIDE
This topic covers the significance of the annual notice of
change for beneficiaries enrolled in Medicare Advantage
Annual Notice of Change plans. 5 Qs 8.8%
This topic examines the prior authorization requirements for
Prior Authorization Processes services and medications within Medicare Advantage. 5 Qs 8.8%
Medicare Advantage Plan This topic looks at the star rating system and its implications
Ratings for Medicare Advantage plans. 5 Qs 8.8%
This topic focuses on the unique considerations and options
Dual Eligible Beneficiaries available for dual eligible beneficiaries under Medicare. 4 Qs 7.0%
This topic discusses compliance issues and audit processes
Compliance and Audits related to Medicare Advantage plans. 4 Qs 7.0%
This topic addresses supplemental benefits aimed at
Chronic Disease Management managing chronic diseases in Medicare Advantage. 4 Qs 7.0%
Total Exam Coverage 12 Integrated Topic Modules 57 Qs 100.0%
TOPIC 1: MEDICARE ADVANTAGE ENROLLMENT
5 Questions • 8.8% of Exam • This topic covers the enrollment processes and eligibility criteria for Medicare Advantage plans.
QUESTION 1
A 72-year-old veteran with dual eligibility is considering enrollment in a Medicare
Advantage Special Needs Plan (SNP) for chronic condition management. Which of the
following is a required feature of a chronic condition SNP?
A) Must provide at least one supplemental benefit not covered by Original Medicare
B) Must limit enrollment to beneficiaries with the specific chronic condition
C) Must require a higher Part B premium than standard MA plans
D) Must offer a zero-premium Part D plan
Answer: Must limit enrollment to beneficiaries with the specific chronic condition.
Rationale: Chronic condition SNPs enroll only beneficiaries who have the designated chronic condition.
Confidential • Student Study Edition • Practice & Review Guide Page 2 of 30
, STUDENT STUDY & MASTERY EDITION PRACTICE & REVIEW GUIDE
QUESTION 2
Mrs. Alvarez, age 80, is eligible for both Medicare and Medicaid. She is offered a
Medicare Advantage plan that includes a prescription drug benefit. What is the impact
of her Medicaid status on her Part B premium?
A) She will still pay the full Part B premium
B) Her Part B premium will be reduced by 50%
C) She will not owe any Part B premium
D) Her Part B premium will be covered by the MA plan
Answer: She will not owe any Part B premium.
Rationale: Dual-eligible beneficiaries are exempt from paying the Part B premium.
QUESTION 3
A 45-year-old employee is transitioning from employer group health to Medicare after
retirement.
He wants to keep his current prescription drug coverage. Which Medicare option allows
him to retain his employer's drug formulary while gaining Medicare Part A and B
benefits?
A) Enroll in a Medigap Plan F and keep the employer's drug plan
B) Enroll in a Medicare Advantage plan with a prescription drug benefit
C) Enroll in Original Medicare and a separate Part D plan that mirrors his employer's formulary
D) He cannot retain the employer's drug coverage once he enrolls in Medicare
Answer: Enroll in Original Medicare and a separate Part D plan that mirrors his employer's formulary.
Rationale: Original Medicare combined with a Part D plan can be selected to match the employer's formulary.
Confidential • Student Study Edition • Practice & Review Guide Page 3 of 30
AHIP Final Exam 2026/2027 Verified
Exam Questions with Solutions and
Correct Answer Keys
Comprehensive Examination Question Bank • Concept Mapping
TOTAL QUESTIONS EXAM TOPICS ANSWERS
57 Questions 12 Modules 100% Verified
DOCUMENT OVERVIEW
This document contains 57 verified questions with correct answers and detailed rationales focused on
Medicare Advantage and related policies. It provides essential insights into the operational and regulatory
aspects of Medicare programs, making it suitable for study, review, and certification preparation in health
insurance and Medicare policy.
EXAM BLUEPRINT & TOPIC DISTRIBUTION
Systematic breakdown of subject domains and exam coverage.
Topic Module Scope & Core Focus Questions Share (%)
This topic covers the enrollment processes and eligibility
Medicare Advantage Enrollment criteria for Medicare Advantage plans. 5 Qs 8.8%
This topic examines the rules and provisions regarding
Supplemental Benefits supplemental benefits offered in Medicare Advantage plans. 5 Qs 8.8%
This topic focuses on the metrics and implications of quality
Quality Bonus Payments bonus payments for Medicare Advantage plans. 5 Qs 8.8%
This topic addresses various cost-sharing mechanisms and
Cost Sharing and Payments payment structures within Medicare Advantage. 5 Qs 8.8%
This topic explores telehealth provisions and their integration
Telehealth Services into Medicare Advantage plans. 5 Qs 8.8%
This topic investigates the role of provider networks and their
Provider Networks impact on beneficiary choices in Medicare Advantage. 5 Qs 8.8%
Confidential • Student Study Edition • Practice & Review Guide Page 1 of 30
,STUDENT STUDY & MASTERY EDITION PRACTICE & REVIEW GUIDE
This topic covers the significance of the annual notice of
change for beneficiaries enrolled in Medicare Advantage
Annual Notice of Change plans. 5 Qs 8.8%
This topic examines the prior authorization requirements for
Prior Authorization Processes services and medications within Medicare Advantage. 5 Qs 8.8%
Medicare Advantage Plan This topic looks at the star rating system and its implications
Ratings for Medicare Advantage plans. 5 Qs 8.8%
This topic focuses on the unique considerations and options
Dual Eligible Beneficiaries available for dual eligible beneficiaries under Medicare. 4 Qs 7.0%
This topic discusses compliance issues and audit processes
Compliance and Audits related to Medicare Advantage plans. 4 Qs 7.0%
This topic addresses supplemental benefits aimed at
Chronic Disease Management managing chronic diseases in Medicare Advantage. 4 Qs 7.0%
Total Exam Coverage 12 Integrated Topic Modules 57 Qs 100.0%
TOPIC 1: MEDICARE ADVANTAGE ENROLLMENT
5 Questions • 8.8% of Exam • This topic covers the enrollment processes and eligibility criteria for Medicare Advantage plans.
QUESTION 1
A 72-year-old veteran with dual eligibility is considering enrollment in a Medicare
Advantage Special Needs Plan (SNP) for chronic condition management. Which of the
following is a required feature of a chronic condition SNP?
A) Must provide at least one supplemental benefit not covered by Original Medicare
B) Must limit enrollment to beneficiaries with the specific chronic condition
C) Must require a higher Part B premium than standard MA plans
D) Must offer a zero-premium Part D plan
Answer: Must limit enrollment to beneficiaries with the specific chronic condition.
Rationale: Chronic condition SNPs enroll only beneficiaries who have the designated chronic condition.
Confidential • Student Study Edition • Practice & Review Guide Page 2 of 30
, STUDENT STUDY & MASTERY EDITION PRACTICE & REVIEW GUIDE
QUESTION 2
Mrs. Alvarez, age 80, is eligible for both Medicare and Medicaid. She is offered a
Medicare Advantage plan that includes a prescription drug benefit. What is the impact
of her Medicaid status on her Part B premium?
A) She will still pay the full Part B premium
B) Her Part B premium will be reduced by 50%
C) She will not owe any Part B premium
D) Her Part B premium will be covered by the MA plan
Answer: She will not owe any Part B premium.
Rationale: Dual-eligible beneficiaries are exempt from paying the Part B premium.
QUESTION 3
A 45-year-old employee is transitioning from employer group health to Medicare after
retirement.
He wants to keep his current prescription drug coverage. Which Medicare option allows
him to retain his employer's drug formulary while gaining Medicare Part A and B
benefits?
A) Enroll in a Medigap Plan F and keep the employer's drug plan
B) Enroll in a Medicare Advantage plan with a prescription drug benefit
C) Enroll in Original Medicare and a separate Part D plan that mirrors his employer's formulary
D) He cannot retain the employer's drug coverage once he enrolls in Medicare
Answer: Enroll in Original Medicare and a separate Part D plan that mirrors his employer's formulary.
Rationale: Original Medicare combined with a Part D plan can be selected to match the employer's formulary.
Confidential • Student Study Edition • Practice & Review Guide Page 3 of 30
